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This article considers the etiology, diagnosis and treatment of fire setting. The causes reported include child abuse, identification problems, poor parent relationship and severe conduct disorders. Diagnosis is varied and rarely specific. Treatment approaches vary and include close observation, negative practices or satiation procedures and positive and negative reinforcement.
This study compares firesetting children with an age- and sex-matched group of non-firesetting children referred to a child psychiatric outpatient service. Firesetting was associated with male sex, separated parents and with previous contact with welfare agencies. It was not associated with socioeconomic status. Firesetters were distinguished from the contrast group by higher levels of conduct disordered behaviour, particularly in children above the age of 11 years. Both groups had similar high levels of emotional disorder at all ages. These clinical features emphasise that firesetters have a mixed clinical picture with widespread psychopathology.
OBJECTIVE: To determine whether men and women with bipolar disorder differ in age of onset, course of illness, number of suicide attempts, comorbidity rates and symptom presentation. METHOD: Data were collected from 211 (121 women; 90 men) adults using the Diagnostic Interview for Genetic Studies, medical records, and additional information gathered from relatives. RESULTS: Most gender comparisons showed no evidence of differences. Nonetheless, more men than women reported mania at the onset of bipolar I disorder. Men also had higher rates of comorbid alcohol abuse/dependence, cannabis abuse/dependence, pathological gambling and conduct disorder. Men were more likely to report 'behavioural problems' and 'being unable to hold a conversation' during mania. Women reported higher rates of comorbid eating disorders, and weight change, appetite change and middle insomnia during depression. CONCLUSIONS: Men and women were generally similar in their symptom presentation, age of onset of bipolar disorder, and in the total number of mood episodes. However, they differed in the type of episode at onset and comorbidity patterns.
INTRODUCTION: Several different follow-up studies have shown that attention deficit hyperactivity disorder (ADHD) can persist into adulthood. AIM: To review the findings in adults with ADHD related to alterations in the executive functions. DEVELOPMENT: Research conducted among children with ADHD has revealed the existence of alterations in different tasks that evaluate the executive functions, such as the planning test, sustained attention tasks, cognitive flexibility, verbal fluency and working memory tasks, as well as several inhibition response tasks. In adults with ADHD, despite the lower number of reports in the literature and the methodological shortcomings that exist in some studies, analogous results have also been described with respect to executive functioning, namely, disorders affecting inhibition response, the capacity for planning, difficulties in cognitive flexibility and verbal fluency, and problems with working memory, which include aspects of spatial working memory, logical or visual memory. CONCLUSIONS: The findings we have available at present enable us to confirm the persistence of executive dysfunctions in adult patients with ADHD that are similar to those observed in children with ADHD.
Although the high comorbidity of posttraumatic stress disorder (PTSD) and substance use disorders has been firmly established, no laboratory-based studies have been conducted to examine relationships between the two disorders. Using cue reactivity methodology, this study examined the impact of personalized trauma-image cues and in vivo drug cues on drug-related responding (e.g. craving) in individuals with PTSD and either crack cocaine (CD) or alcohol dependence (AD). CD and AD groups displayed reactivity to both trauma and drug cues when compared to neutral cues, including increased craving. However, the AD group was more reactive than the CD group to both classes of cues. The CD participants were more reactive to trauma-image cues if drug-related material was included in the image while the AD participants were reactive to the trauma cues regardless of drug-related content. It is hypothesized that PTSD-related negative emotion may play a relatively more important role in the maintenance of AD when compared to CD. Evidence that substance dependent individuals with PTSD report increased substance craving in response to trauma memories is offered as a potential contributing factor in the poorer substance abuse treatment outcomes previously documented in this comorbid population.
Psychophysiological responses are considered to be a mediating factor in the development of pathological gambling (PG) and PG has been associated with differential arousal levels during gambling. Yet little is known about the specific psychophysiological responses to wins and losses in PG. This study investigated heart rate (HR) and skin conductance responses (SCRs) during the Iowa Gambling Task (IGT) in an adult PG group (n=46) and a normal control (NC) group (n=47). Anticipatory psychophysiological reactions to disadvantageous and advantageous choices during the IGT and psychophysiological responses to wins and losses were measured. The PG group performed worse than the NC group on the IGT and exhibited lower anticipatory SCRs and HR decreases when pondering choices of disadvantageous card decks during the IGT. The PG group showed a decrease in HR after losses and wins, whereas the NC group showed a decrease in HR after losses, but an increase in HR after wins. Reward and punishment sensitivity as measured by the self-report BIS/BAS scale influenced IGT performance and psychophysiological responses, but in general these effects were similar for the PG group and the NC group. Lower anticipatory psychophysiological responses to disadvantageous choices in PG suggest impaired risk assessment in this group. Absence of a HR increase after wins possibly implies that reward sensitivity is decreased in PG. Because levels of reward and punishment sensitivity were associated with differential anticipatory HR responses to advantageous and disadvantageous decks, it would be advisable to include this taxonomy in studies on psychophysiological responses to rewards and losses.
BACKGROUND: There is an extensive literature describing a central serotonin deficit in alcoholic, impulsive, violent offenders and fire setters. In the present study, we investigated biochemical concomitants of impulsivity and aggressiveness, and the physiological consequences of reduced central serotonin turnover. METHODS: Forty-three impulsive and 15 nonimpulsive alcoholic offenders and 21 healthy volunteers were studied in the forensic psychiatry ward of a university psychiatric department. The subjects underwent lumbar punctures and oral glucose and aspartame challenges, and their diurnal activity rhythm was measured with physical activity monitors. Discriminant function analyses were used to investigate psychophysiological and biochemical concomitants of aggressive and impulsive behaviors. RESULTS: Alcoholic, impulsive offenders with antisocial personality disorder had low mean cerebrospinal fluid (CSF) 5-hydroxyindoleacetic acid (5-HIAA) and corticotropin levels and high mean CSF testosterone concentrations. Compared with healthy volunteers, they showed increased physical activity during the daytime. Alcoholic, impulsive offenders with intermittent explosive disorder had a low mean CSF 5-HIAA concentration and blood glucose nadir after an oral glucose challenge, and desynchronized diurnal activity rhythm. Healthy volunteers had mean CSF 5-HIAA concentrations that were intermediate between those of alcoholic, impulsive and nonimpulsive offenders. Alcoholic, nonimpulsive offenders had a significantly higher mean CSF 5-HIAA concentration than all the other groups, including healthy volunteers. CONCLUSIONS: In the present sample, a low CSF 5-HIAA concentration was primarily associated with impulsivity and high CSF testosterone concentration, with aggressiveness or interpersonal violence.
We report on 6 patients with Parkinson's disease who developed severe repetitive behavior, 2 with pathological gambling and 4 with cleaning, rearranging, and ordering rituals. The onset of repetitive behaviors was not associated with changes in antiparkinsonian medications, the behavior did not improve after reductions in dopaminergic therapy, and thus they seem to be part of the underlying illness. The disabling cleaning/rearranging/ordering behaviors had associated features of hypomania, occurred exclusively during motor on periods, and often occurred nocturnally. The repetitive behavior responded poorly to serotonin reuptake inhibitors. Certain atypical antipsychotics may be of benefit.
Several lines of evidence indicate that dopaminergic neurotransmission is involved in the regulation of impulsive aggression and violence and that genetically determined variability in dopaminergic gene expression modifies complex traits including that of impulsivity and aggression. In this study we report an association of the dopamine D3 receptor (DRD3) polymorphism with impulsiveness according to Eysenck's EIQ and scores on the German short version of the Wender Utah Rating Scale (WURS-k), which we used for the assessment of a history of ADHD-related symptoms. This association was detected in a group of violent offenders, but not in non-violent individuals. Highest scores of EIQ impulsiveness and of the WURS-k were found in heterozygous violent individuals, while homozygotes showed significant lower rating scores, suggesting an heterosis effect. The results of our study suggest that variations of the DRD3 gene are likely involved in the regulation of impulsivity and some psychopathological aspects of ADHD related to violent behavior.
Impulsivity, broadly defined as action without foresight, is a component of numerous psychiatric illnesses including attention deficit/hyperactivity disorder (ADHD), mania and substance abuse. In order to investigate the mechanisms underpinning impulsive behavior, the nature of impulsivity itself needs to be defined in operational terms that can be used as the basis for empirical investigation. Due to the range of behaviors that the term impulsivity describes, it has been suggested that impulsivity is not a unitary construct, but encompasses a variety of related phenomena that may differ in their biological basis. Through fractionating impulsivity into these component parts, it has proved possible to devise different behavioral paradigms to measure various aspects of impulsivity in both humans and laboratory animals. This review describes and evaluates some of the current behavioral models of impulsivity developed for use with rodents based on human neuropsychological tests, focusing on the five-choice serial reaction time task, the stop-signal reaction time task and delay-discounting paradigms. Furthermore, the contributions made by preclinical studies using such methodology to improve our understanding of the neural and neurochemical basis of impulsivity and ADHD are discussed, with particular reference to the involvement of both the serotonergic and dopaminergic systems, and frontostriatal circuitry.
Research on intermittent explosive disorder (IED) has been hindered by vague and restrictive DSM-IV diagnostic criteria. Integrated research criteria have been developed for IED (IED-IR) that address the DSM-IV criteria's shortcomings. The purpose of this study was to examine the convergent and discriminant validity of the IED-IR criteria set by comparing adults meeting these criteria (n=56) to healthy controls (n=56) and to individuals with an Axis I major mental disorder (n=33) or an Axis II personality disorder (n=22) diagnoses on measures of aggression (self-report and behavioral) and global functioning. IED-IR individuals demonstrated higher levels of aggression compared to the other three groups, and were rated as more impaired than the healthy control and Axis I individuals. Subgroup analyses showed that IED-IR subjects who did not meet DSM IED criteria did not differ from DSM IED subjects on self-report measures of aggressiveness or global functioning. Furthermore, the IED-IR subjects evidenced more behavioral aggression than their DSM-IED counterparts.
Performance measures of impulsiveness offer great promise for assessing this trait in clinical and experimental studies. However, little is known about their relative superiority or inferiority to standard cognitive performance measures as correlates of this trait. In this study, 58 healthy volunteers completed a self-rating of impulsiveness (Barratt Impulsiveness Scale) and a battery of neuropsychological tests. The test battery included measures of reaction time, attention, memory, fluency, and executive function, as well as two performance measures of impulsiveness--Time Estimation and a Go-No Go task. Self-ratings correlated moderately with a number of these test scores, but many correlations became non-significant after adjustment for age and education. Correlations with the Go-No Go task, verbal fluency, executive function measures (Trails B), and tasks requiring decision-making against time (Choice Reaction Time, Reaction Time to Paired Words and Paired Faces Memory Tasks, and response bias on the Continuous Performance Test) remained significant. Performance on the Go-No Go task was the strongest correlate of self-rated impulsiveness. The findings suggest that once general demographic or ability factors are accounted for, specialized performance tasks requiring decision-making and response organization under time pressure provide the most effective means of assessing this behavioral trait.
Serotonin (5-HT) function is altered in several psychiatric disorders, including cocaine dependence (CD), and its role in impulsive-aggressive behaviors has been widely studied. However, the relationship between psychopathological and behavioral dimensions and mechanisms of 5-HT alterations remains unclear. We investigated the relationship of a polymorphism in the 5' promoter region of the serotonin transporter gene (5-HTTLPR) with prolactin (PRL) response to meta-chlorophenylpiperazine (m-CPP) in a sample of 68 African-American individuals, 35 CD subjects and 33 controls. We also examined whether measures of impulsivity, hostility and sensation seeking influenced the relationship between the 5-HTTLPR polymorphism and PRL response to m-CPP in this sample. Individuals with the SS genotype showed significantly heightened PRL response to the challenge compared with the LL and LS genotypes. No influence of gender or substance abuse condition was observed. Hostility was associated with blunted PRL response in the total sample. Cocaine abuse was the most significant moderator of DeltaPRL (peak PRL-baseline PRL), and the interaction of genetic, behavioral and psychopathological measures helped predict most of the observed DeltaPRL (62.5%). Although these results need replication, variation in the 5-HTTLPR gene appears to influence measures of 5-HT function and interact with disease state and personality dimensions to account for 5-HT disturbances in African-American populations.
Mobius syndrome is a rare disorder characterized by agenesis or aplasia of the facial or abducens nerve motor nuclei and other features including central nervous system and behavioral abnormalities. We report an adult case of Mobius syndrome variant presenting with poor impulse control, aggression, and exhibitionism. Karyotyping revealed a 46 XY, t(1;13)(p34.3;q12.3) translocation. The subject had been presented 20 years previously as the index case of a three-generation pedigree.
Cocaine addiction affects brain reward centers that have evolved to ensure survival. Cocaine euphoria is intensely pleasurable and results from mesolimbic dopamine (DA) neurotransmission. DA signal-receiving neurons in the nucleus accumbens synthesize endogenous opioids and project to numerous reward regions. Cocaine-induced neuroadaptations, including DA depletion, may underlie craving and hedonic dysregulation. Cue-induced craving is vigorously triggered by conditioned elements of the drug environment and associated with measurable limbic activation. Reduced frontal lobe metabolism in cocaine-addicted individuals could explain important clinical phenomena such as denial and the loss of control over limbic impulses. Cocaine addiction is rapidly progressive and associated with severe medical, psychiatric, and psychosocial consequences. Denial shields addicted individuals from their predicament and must be addressed in treatment. Lacking pharmacological options, clinicians must rely entirely on psychosocial approaches. Treatment principles, including engagement, motivational enhancement, abstinence strategies, and craving reduction are discussed in terms of biological rationales.
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A. Holtzworth-Munroe and G. L. Stuart (1994) proposed that 3 subtypes (family only [FO], borderline-dysphoric [BD], and generally violent-antisocial [GVA]) would be identified using 3 descriptive dimensions (i.e., severity of marital violence, generality of violence, psychopathology) and would differ on distal and proximal correlates of violence. Maritally violent men (n = 102) and their wives were recruited from the community, as were 2 comparison groups of nonviolent couples (i.e., maritally distressed and nondistressed). Four clusters of violent men were identified. Three resembled the predicted subtypes and generally differed in the manner predicted (e.g., FO men resembled nonviolent groups: BD men scored highest on measures of dependency and jealousy; GVA men had the most involvement with delinquent peers, substance abuse, and criminal behavior; and both BD and GVA men were impulsive, accepted violence, were hostile toward women, and lacked social skills). The 4th cluster (i.e., low-level antisocial) fell between the FO and GVA clusters on many measures.
Case reports are given of three patients, two suffering from compulsive shop-lifting and one from binge-eating, who responded to a week's treatment with imaginal desensitization after having failed to respond to prolonged interpretative psychotherapy. Expectancy of improvement did not appear to play a major role in their response, but it appears impossible to disprove that expectancy determines the response to this or any form of psychotherapy. Whether or not imaginal desensitization acted specifically in the present study, in view of its cost-efficacy it is suggested it is worthy of trial in impulse disorders which have persisted despite treatment.